Many patients believe that minimally invasive methods are the best option “Spine Surgery Using Lasers.” Laser spine surgery, on the other hand, is never recommended. Dr. Stephen P. Banco, previously of The Reading Neck and Spine Practice, has spent years educating patients about the dangers of lasers in spinal surgery and will continue to do so at his new comprehensive spinal treatment center, Keystone Spine and Pain Management. The truth about laser spine surgery is that it is ineffective and not covered by insurance.
Laser spine surgeons, in essence, execute the same process as any other spine surgeon, but with the addition of a laser “Laser” is used at the conclusion of the procedure. Patients, on the other hand, face an additional fee of up to $30,000 for this additional service! It’s the equivalent of purchasing a car but being charged $30,000 for floor mats. The FDA has not approved laser spine surgery, and it is not covered by insurance. It will almost probably not be covered under Obamacare (Affordable Care Act) or any other private insurance in the future.
Is the Laser Spine Institute legitimate?
In order to gain business, Laser Spine Surgeons spread a variety of myths and fallacies.
H. Gordon Deen, a neurosurgeon at the famed Mayo Clinic, claimed in a 2009 article, “At Mayo Clinic, we do not employ or advocate laser spine surgery.” Although laser spine surgery has been known since the 1980s, it has never been tested in a randomized controlled trial to assess its efficacy. Most neurosurgeons avoid using lasers for spine surgery because “there are no evident benefits to laser surgery over well-established, effective spine surgery techniques.” This appears to be strange. A number of Spine Surgeons and big practices that include Spine Surgeons, such as the Laser Spine Institute, have actively advertised surgical techniques for which there has never been a controlled clinical research to prove their usefulness. In contrast, there are many opponents of laser spine surgery, and in the context of vehicle accident cases, this operation has served no purpose other than to line the pockets of unscrupulous physicians, in my opinion.
Laser spine surgery, in my opinion (and that of the majority of Orthopedic Spine Surgeons and Neurosurgeons), is at most a procedure(s) that may be effective for a very tiny segment of persons suffering from persistent back or neck discomfort caused by discogenic (i.e., disc-related) pathology. Many surgeons who conduct laser spine surgery, particularly those who specialize in laser spine surgery, tend to use these treatments as a one-size-fits-all approach to treating all sorts of back and neck disease and symptomatology. It may be claimed that many surgeons seek such procedures for financial benefit rather than ethical reasons.
In their brochures or mailings, medical practices advocating laser spine surgery, or the surgeons who actively conduct such operations, will frequently say that laser spine surgery is minimally invasive. This is sometimes misleading because laser spine surgery is a severe procedure that necessitates an incision (sizeable opening). Cutting bone, ligament, and joint fragments out by tearing through muscle. The bone, ligaments, and joint fragments that are removed are frequently healthy and normal, and removing them causes permanent injury to the area, resulting in pathology and symptomatology. As a result, the patient will require further procedures and operations in the future to address the complications that the laser spine surgery has produced or aggravated. In other words, the vast majority of laser spine surgeries serve no genuine medical purpose and are frequently utilized to treat disease that is minor or non-existent, with the patient developing persistent pathology as a result of such dubious medical procedures. The procedures are also sold to those who have severe symptoms caused by extensive discogenic pathology for which LaserSpine surgery is not a viable treatment option.
For greedy Orthopedic Spine physicians and Neurosurgeons, laser spine operations like the percutaneous endoscopic discectomy have acted as cash cows. Attempting to cure or decompress a disc with an annular tear that is symptomatic in nature by drilling a new hole in an already damaged disc is nonsensical, according to legitimate research. Placing even a small hole in the disc’s edge exposes it to significant corruption. The hole will very certainly worsen to the point where the patient will get degenerative disc degeneration. The hole will most certainly spread and could extend all the way into the nucleus, causing another annular tear. As a result, the laser spine surgery may put the patient on a one-way route to needing a fusion to fix the injured disc.
In recent months, the Laser Spine Institute in Tampa has come under fire for selling a series of very similar laser spine operations. Author David Armstrong demonstrates in a Bloomberg piece that Laser Spine Institute and its competitors offer laser spine surgery that lacks any independent research that documents the procedure’s success or outcomes. In truth, Laser Spine Institute has a shady reputation, with a rate of malpractice claims per 1000 surgeries that is several times higher than the average for all outpatient surgical centers in the United States. That is very incredible. Medical practices are doing surgeries with no independent research to back them up, and the malpractice rate is many times higher than the national average. It makes me wonder why anyone in their right mind would go to the Laser Spine Institute for surgery.
The fact that Laser Spine Institute frequently costs more than $30,000.00 for a surgery is even more disturbing. This is at least twice as much as Aetna (the third largest health insurance company in the United States) will pay for a laser-free surgery, according to the author. Furthermore, the author shows that several of the Laser Spine Institute’s surgeons are shareholders in the company. At Laser Spine Institute, individual surgeons do up to 5000 surgeries every year. It begs the question of whether these procedures are performed for legitimate reasons or for the financial incentives they provide to the corporation’s owners.
When a plaintiff attorney submits a demand for the at-fault party’s bodily injury coverage after the claimant has undergone laser spine surgery, many motor insurance carriers simply red flag the claim. Many interventional pain management specialists (such as Physiatrists and Anesthesiologists) offer the same procedures and bill between $5000.00 and $8000.00 for a procedure that Surgeons bill in excess of $30,000.00. At trial, defense attorneys focus their arguments on the billing expenses for such operations. The argument is that the surgery is not only questionable in nature, but that the objective of doing it is centered on financial gain rather than the patient’s well-being. In recent years, a number of cases involving percutaneous endoscopic discectomies have resulted in defense verdicts throughout Florida, particularly in Pinellas County.
As a personal injury lawyer in Clearwater, I’ve noticed a significant increase in the number of surgeons in Pinellas, Manatee, Pasco, and Hillsborough counties who offer laser spine surgery and market attorneys and other physicians for clients/patients who have suffered back or neck injuries in the last five years.
Matthew A. Dolman, Esq., is a personal injury lawyer in Clearwater who focuses on first and third-party insurance claims involving vehicle accidents, wrongful death, traumatic brain injury, motorcycle accidents, catastrophic injuries, and insurance carrier bad faith. Sibley Dolman Gipe Accident Injury Lawyers, PA is a personal injury and civil trial legal practice with offices in Clearwater and Bradenton that litigates first and third-party insurance claims in Pinellas, Manatee, Hillsborough, Pasco, and Sarasota Counties.
What is the average cost of laser spine surgery?
Many patients who are considering laser spine surgery are unaware that many insurance companies still consider the operation experimental, which means they are unwilling to fund the accompanying costs.
This is significant since laser spine operations can cost anywhere from $4,000 to $90,000, and many patients are surprised to learn that their insurance does not cover them, leaving them to foot the tab on their own.
For example, the now-defunct Laser Spine Institute cost around $30,000 for spine surgery, which is more than double what Aetna would pay, and Cigna won’t cover the laser portion at all.
Is Laser Spine Institute out of business?
After a series of financial setbacks and lawsuits, Tampa-based Laser Spine Institute closed its doors in March 2019, 14 years after it first opened.
According to the Tampa Bay Times, Laser Spine Institute was founded in 2005 by three physicians, James St. Louis, MD, Glenn Hamburg, MD, and Michael Perry, MD, with nine personnel and one operation room.
At its peak, the practice employed over 1,000 people and operated surgery sites in Tampa, St. Louis, Cincinnati, and Scottsdale, Arizona.
It built a $56 million, 176,000-square-foot headquarters in Tampa in 2016. The practice made $220 million in income the next year, up from $216.9 million the year before.
Despite its excellent revenue growth, Laser Spine Institute was mired in a slew of major lawsuits.
A competitor spine center filed the most major complaint in 2006, accusing Laser Spine Institute of breach of fiduciary duty, defamation, tortious interference, and violation of a Florida law, among other things.
A federal court ordered Laser Spine Institute to pay the complainant $264 million in damages in 2018. The practice’s demise began with a spate of operation center closures and a decreased operating cost structure.
After the banks blocked Laser Spine Institute’s accounts and deprived them of cash in March 2019, the practice closed its Tampa headquarters and remaining sites, laying off 354 employees.
Highwoods Properties, a real estate investment firm, leased three of the Tampa headquarters’ six floors in February 2020.
The surgery center in the facility is still vacant, but sports retailer Fanatics Brands has leased 92,000 square feet of the 176,000-square-foot property.
Why did the Laser Spine Institute close?
TAMPA, Fla. The Laser Spine Institute may have abruptly shuttered its doors in March, but the consequences of the surgery center’s business tactics are still being felt in the courts.
Two local lawsuits paint the clearest picture yet of the factors that led to the Tampa company’s closure and the loss of 500 employment. Documents reveal a years-long court dispute between three business partners, as well as a proclivity for paying huge executive salaries and incentives and a fight against increasing debt.
Another consideration is ego. Two of the founders once dared their partner to sue them, saying him it wouldn’t matter because the company was producing so much money. When the partner called their bluff, his lawsuit proved to be the final nail in the coffin for Laser Spine.
Joe Samuel Bailey was awarded $260 million in damages by a court in Hillsborough County Circuit Court on June 30, completing a 13-year legal struggle between Bailey and Laser Spine founders Dr. James St. Louis and Dr. Michael Perry.
They were charged with breach of fiduciary duty, slander, defamation, violation of the Florida Deceptive and Unfair Trade Practices Act, conspiracy, and tortious interference, according to Bailey.
He currently owns a majority share of Laser Spine, which is in the midst of an insolvency procedure, after two lengthy bench trials and appeals. The process evaluates all equipment and other materials Laser Spine owns or controls, similar to a federal bankruptcy petition, and determines what is worth enough to sell.
“My client’s business was destroyed in 2004, and here we are in 2019, and he has still not gotten any compensation,” Jennifer Altman, a Miami attorney who represented Bailey, said. “This is a case of long-delayed justice. However, we’re really happy with the outcomes, which we believe are correct.”
Bailey’s case was convoluted, but it was well-known in some circles for its odd twists and turns. It’s rooted in the health-care industry’s interactions with marketing, public relations, financing, and high-profile doctors’ egos. It also focuses on the executive decisions that appear to have led to the company’s demise.
Bailey worked with St. Louis and Perry in the past as a marketing consultant for the Bonati Institute in Pasco County. The Laserscopic Spinal Centers of America, Inc., and its parent businesses were created in 2004. Patients were first treated with minimally invasive spinal surgery at the practice.
According to a 2016 appeals court brief, Laserscopic’s business model was unique at the time, and St. Louis was one of less than 10 surgeons in the US who specialized in endoscopic minimally invasive spine surgery. Bailey, Perry, St. Louis, and another partner, Ted Suhl, were the company’s four directors and each held a share of the company’s ownership.
Revenue increased from roughly $100,000 in August 2004 to $250,000 in September of the same year. According to court filings, it had reached $650,000 by October of that year.
The early expansion piqued the interest of EFO Holdings L.P., an investment firm.
EFO partners William Esping and Robert Grammen offered to invest $3 million in Laserscopic Spinal in exchange for 55 percent ownership, control of the board of directors, and a 7% return on vested capital. Bailey was under duress, according to court filings.
“Either you accept our deal or we’ll take your doctors and your business.” And we’re going to go up the street and do it ourselves,” Grammen told Bailey, according to the records. Requests for response from St. Louis, Perry, and their attorneys were not returned.
St. Louis and Perry informed Bailey two days after EFO offered to invest that they were leaving Laserscopic Spinal to form a rival company with the EFO investment firm. According to court filings, St. Louis and Perry met privately with Esping and Grammen multiple times. They went on to form the Laser Spine Institute barely 22 days after making their first offer to Laserscopic.
Is nerve damage from herniated disk permanent?
The majority of patients seek therapy for a herniated disc because the pain is unbearable and they need relief. While some people claim to have a high pain tolerance and wait for the problem to go away, this does not mean they have recovered. In fact, if left untreated, a herniated disc can lead to much more serious and chronic problems. It’s advisable to see an Atlanta chiropractor as soon as you notice this problem to avoid it getting worse.
A significant bulging disc might cut off nerve signals, resulting in lasting nerve damage. As the problem progresses, you may also have acute pains, incontinence, bowel movement irregularity, or even partial paralysis. Saddle anesthesia is a condition in which the nerves are pinched to the point where sensation is lost in the inner thighs, back of the legs, and the area surrounding the rectum.
While a herniated disc may typically be cured without surgery, if the condition is left untreated, it may worsen to the point where surgery is the only option.
Seeking Treatment
As soon as you notice discomfort that is interfering with your quality of life, you should consult an Atlanta chiropractor to determine the severity of your slipped disc. You’ll probably be asked to complete a number of tasks aimed at assessing your nerves, such as walking strength, reflexes, and the ability to feel light touches. This will usually suffice to diagnose the problem, though you may be referred for imaging in some situations.
They will be able to build a treatment plan that matches your needs based on the results. While they may prescribe pain medication initially, they will most likely collaborate with you and a physical therapist to build an exercise program to strengthen the back, neck, and abdominal muscles. If this does not help your pain, you may be given cortisone injections to address the problem more directly.
Is laser spine surgery FDA approved?
Back pain is a highly prevalent ailment that affects 60 percent to 80 percent of persons at some point during their lives. Back pain is the most often reported type of chronic pain in Canada, accounting for over one-third of all chronic pain cases. 3 Back pain is severe for an estimated 80% to 90% of sufferers, and it either goes away on its own or responds to medical and/or non-surgical treatment. 4,5 A small percentage of people with back pain symptoms that last longer than 12 weeks are considered to have chronic back pain. 6
Chronic back pain is frequently caused by a herniated disc and/or nerve root entrapment.
The inner nucleus of the disc protrudes through the outer annulus into the intervertebral space in patients with herniated discs, squeezing nerve tissue and producing discomfort.
9 Nerve root entrapment can be caused by a herniated disc, but it can also be caused by other disorders, such as spinal stenosis10. It causes radicular pain that spreads into a limb, causing discomfort and/or paralysis. 11 Patients with these disorders may experience a wide range of symptoms, ranging from mild or minor discomfort to severe pain, impairment, and disruption of daily life and activities. 4,7,12 Chronic back pain, such as that caused by a herniated disc and/or nerve root entrapment, is described as a major contributor to disability13 and/or hospitalization. 1
Surgical intervention may be necessary for individuals with chronic back pain caused by a herniated disc and/or nerve root entrapment; however, long-term outcomes may be comparable to those in patients who receive less intrusive, medicinal or non-surgical therapy.
6,8 Patients with herniated discs and/or nerve root entrapment typically undergo open surgery, which poses a significant risk of infection and/or protracted patient recovery. 5,8 As a result, during the last several decades, minimally invasive surgical techniques have evolved, relying on a variety of equipment and techniques, including lasers. Percutaneous laser disc decompression is a term used to describe laser spine surgery for herniated discs (PLDD). 7,11,14
PLDD uses a catheter or cannula to insert a laser surgical tool into the intervertebral space, similar to other minimally invasive surgical methods. The laser directs focused light energy and heat to the nucleus of the disc, vaporizing water content and modifying the disc’s protein structure, easing intradiscal pressure. 4 The operation, like other open and minimally invasive methods, is designed to relieve pressure on any damaged nerve root and/or minimize disc herniation (s). 11 Theoretical and alleged advantages of using lasers in minimally invasive spine surgery operations include a lesser risk of harm to surrounding tissues, a lower chance of infection, and a faster recovery period. 12,15
Despite the fact that the United States’ Federal Drug Administration (FDA) approved the use of lasers in percutaneous disc decompression more than 25 years ago,
7,8, there is a general consensus in the literature that there is a paucity of high-quality evidence to guide their use.
6,11,15 The increasing expansion of outpatient laser spine surgery treatment centers, which promise favorable outcomes to patients suffering from herniated discs and persistent back pain sometimes at a significant cost to the patient complicates this vacuum in the data. 16,17
The goal of this paper is to find, summarize, and synthesize information on the clinical effectiveness, cost-effectiveness, and evidence-based guidelines for laser spine surgery in patients with herniated discs and/or nerve root entrapment.
What is the success rate of laser spine surgery?
Lasers are increasingly being used to treat back pain, including common conditions like sciatica, which is a searing pain that travels down the back of your leg.
According to the American Journal of Neuroradiology, the most common cause of sciatica is a herniated disc, which affects roughly 1.5 million people in the United States.
What the Science Suggests
Approximately 20% to 40% of those who are affected will require surgery to find relief. Although traditional lumbar disc surgery entails going under the knife, there are less invasive options available. Percutaneous laser disc decompression (PLDD) is a type of laser spine surgery.
“It’s a lovely concept in your head: take a laser and zap it,” said Mark McLaughlin, MD, a neurosurgeon. “It has a more precise ring to it, with a notion of precision.” It has that ring to it, but it does not offer what the patient expects.” Dr. McLaughlin founded Princeton Brain, Spine, and Sports Medicine, specializing in trigeminal neuralgia and cervical spine surgery.
A rigorous comparison of percutaneous laser disc decompression (PLDD) with both traditional survey and conservative care of lumbar disc herniation is needed, according to a 2006 research published in the American Journal of Neuroradiology (AJNR). Despite the small sample size of only 30 patients, a more recent study from 2019 indicated that the usage of PLDD as a noninvasive therapy lowers pain and disability in patients.
A 2017 study published in AJNR followed two groups of persons who had sciatica surgery. A total of 57 individuals underwent conventional microdiscectomy, while another 55 underwent PLDD. The study indicated that patients who had conventional surgery had a re-operation rate of 21%, whereas those who received PLDD had a re-operation rate of 52 percent after two years.
According to the study, “despite the fact that the rate of reoperation in the PLDD group was higher than expected, surgery could be avoided in 48 percent of those patients who were originally candidates for surgery.” “As a non-surgical approach, percutaneous laser disc decompression could have a role in the treatment arsenal of sciatica caused by confined herniated discs.”
In a 2015 study, the number of reoperations was shown to be lower for both surgeries, but much lower for conventional surgery (16 percent against 38 percent). “Overall, a PLDD strategy with postponed surgery if necessary resulted in noninferior outcomes at one year.”
Drawbacks of Percutaneous Laser Disc Decompression
Dr. McLaughlin, on the other hand, is less optimistic about laser surgery. According to Dr. McLaughlin, lasers emit heat and do not bend around corners like instruments do, nor do they have a precise depth of understanding or penetration. “I don’t believe it’s well suited for “regular spine surgery,” such as decompression, bone spur removal, or reconstructive surgery.
According to Dr. McLaughlin, the conventional approach for a single-level disc herniation causing sciatica is a minimally invasive microdiscectomy. A normal discectomy, which requires a little larger incision than a microdiscectomy, is another alternative.
“A laser will not bring you where you want to go once you get there,” Dr. McLaughlin added. “Bone biters, a drill, even a shaver, anything to debulk the disc constricting the nerve. A laser isn’t the right tool for the job.”
According to McLaughlin, the benefits of a laser do not exceed the possible risks. “My judgment is that occurrences of recurrence are definitely higher with laser decompression because they’re not going to be able to complete the job that physical instruments can,” he said, implying a higher recurrence rate and a higher incidence of heat-related nerve injury.
Nerves come in and out of the spine, curving around corners, and the laser cannot bend or twist, according to Dr. McLaughlin.
When to Use Percutaneous Laser Disc Decompression
Laser surgery, according to orthopedic spine specialist Colin Haines, MD, is well suited to operations that require caution around soft tissue and muscle, such as ultra-minimally invasive surgeries.
According to Haines, any soft tissue that should not be pressed could benefit from laser surgery, which could include spinal stenosis and nerve pressure, soft tissue nerve pressure, facet edema, and sciatica caused by a herniated disc.
Dr. Haines, a spine surgeon at Reston, Virginia’s Virginia Spine Institute (VSI), compared it to a grape. In traditional disc removal operations, an incision is made to remove bone and the grape. The laser is utilized in laser spine surgery to stiffen and shrink the grape, much like a raisin.
“It all boils down to the laser.” “It’s focused light, or heat,” Dr. Haines explained. “Through heating, the laser helps us to shrink tissues.” “There are times when we can do that very effectively,” he explained. In some circumstances, where heat is not appropriate, such as a narrow corridor or nerves that prevent visibility of the issue region, the laser may not be the ideal alternative.
According to Haines, laser surgery can decrease soft tissue like herniations. Endoscopic surgery may be a preferable alternative in other cases. To relieve pressure, a small camera is inserted through an incision and carefully navigated around nerves. “The spine has a lot of nooks and crannies,” he explained. “To access to trouble locations, you may need to gently pull nerves aside and remove a small amount of tissue.”
Recovery from Laser Disc Decompression
One challenge with spine surgery is gaining access to the spine, which is surrounded by a lot of muscle. According to Dr. Haines, this entails large incisions and a lot of muscle cutting, which results in a prolonged healing time.
The length of time it takes to recover is determined by the size of the procedure. Traditional spine surgery takes three to six months, while endoscopic and laser surgery takes three to six days, according to Dr. Haines.
The recovery time from incisional pain, according to Dr. McLaughlin, is one to two weeks “taking it easy” for another two to four weeks, depending on one’s pre-surgery condition and length of illness.
Laser surgery proponents claim that recuperation time is reduced to one week. “That’s because it’s not doing its function of compressing the nerve, according to Dr. McLaughlin. “You’re probably placing the laser on a disc and reducing it a little,” he explained.
According to a research given at the American Institute of Physics conference in 2010, the average time to return to normal work after PLDD is successful is one week. The study, which included over 20,000 surgeries, discovered a success rate ranging from 70% to 89 percent. A recurrence rate of 4% to 5% was discovered after a 23-year follow-up period.
According to Dr. Haines, 90 percent of the time, whether it’s a disc herniation, nerves, or back discomfort, problems can be resolved without surgery.
Dr. Haines expects that as laser technology improves and doctors grow more skilled, laser surgery will become more common. “It isn’t mainstream yet, in my opinion. “Adopting new technologies in health care comes with a lot of obstacles,” he stated.
Patients considering decompression treatments, on the other hand, should seek the advice of a fellowship-trained spinal surgeon so that they can make an informed decision, according to Dr. McLaughlin.
How long is recovery from laser spine surgery?
If you have a herniated or bulging disc in your back that hasn’t responded to conservative treatment, you might be a suitable candidate for laser back surgery. Laser back surgery is a minimally invasive method that has assisted many people in recovering from spinal disorders without the need for invasive open spine surgery. One of the most significant advantages of laser back surgery is that it is a quick operation with a quick recovery time.
Doctors can fix your spine with laser back surgery without having to make a major incision. There is no need to cut through muscle, bone, or other tissue; instead, the doctor makes one or two small incisions near the damaged area of the spine, about the size of a needle. A laser probe, a camera, and any other tools are inserted into these incisions by the doctor.
Traditional spine surgery takes twice as long as laser spine surgery. This is due to the fact that there is no need to make a major incision, sew it, cut through bone, or utilize hardware to fuse the bones together.
Laser back surgery usually takes little more than an hour to complete. You will, however, be required to be in the office for many hours prior to and following the surgery for preparation and observation. You may go home after the physician has examined you and you are no longer drugged.
There is no need for a hospital stay after laser spine surgery because recuperation takes place totally at home. Traditional spine surgery has a significantly longer recovery period and is much more uncomfortable. The majority of patients who work at a desk can return to work in roughly a week. Activity is restricted for a few weeks after surgery, and physical therapy may be required. Within 6 weeks of surgery, you should be fully recovered.
After laser spine surgery, patients can take some actions to ensure that they heal as rapidly as possible. You can, for example, be aware of the signs of complications such as infection so that you can contact your doctor if any issues arise; you can be proactive about moving around as much as recommended and attending physical therapy; and you can avoid over-exerting yourself during the immediate recovery period.
Can laser spine surgery help degenerative disc disease?
If you’re thinking about having back surgery, keep in mind that while minimally invasive surgery with a laser can help with some diseases, it’s not a cure-all, and it’s not for everyone.
How does laser surgery compare with other methods?
Lasers can help certain patients, but only for a limited number of ailments. For those with degenerative spine condition, for example, experts rarely advocate utilizing a laser. Here’s how it compares to other options.
Surgery as it has always been done. The surgeon’s incision in the classic “open” method passes through the skin to the muscle. The surgeon then dissects the muscles away from the spine to create a clean route for working on the spine. While this has the benefit of allowing access to problem regions, it also runs the risk of injuring the surrounding soft tissue, which can result in prolonged hospital stays.
The term “minimally invasive surgery” refers to surgery that is performed with the least amount In comparison to a standard operation, the surgeon makes a smaller incision. He or she tunnels to the source of the discomfort with an instrument. Because the muscles are not lifted from the spine, there is less pain following surgery and the recovery time is frequently shorter, allowing people to resume their normal activities sooner.
Is laser spine surgery better than traditional spine surgery?
That question causes the hair on the back of my neck to stand up. “No,” I say calmly and authoritatively. “I am trained in laser surgery,” I continue. It’s almost useless for spine surgery, and it could even be dangerous.”
Allow me to explain. Lasers have traditionally been associated with cutting-edge accuracy. It’s only logical that incorporating this into surgery would be viewed as something that would benefit and improve procedures by the general population. In fact, lasers have proven to be extremely beneficial in certain surgical procedures. Lasers, for example, are a useful tool in lipomeningocele surgery, which is used to remove fatty tissue that is squeezing or dragging on the spinal cord in an unnatural and dangerous way. The laser, on the other hand, serves no use or function in the vast majority of spine procedures.
At the age of 43, as I approach the midpoint of my career, I want to make sure I’m not the surgeon I swore I’d never be. That is, an older surgeon who refuses to adopt new technologies due to stubbornness or intellectual laziness. I don’t want to be a closed-minded person.
Proponents of laser spinal surgery make a lot of promises. The laser scalpel is better than other surgical choices because it is more technically advanced and minimally intrusive, according to these arguments. In other words, laser surgery should result in less blood loss and scarring. Laser spinal surgery, according to doctors who endorse it, is more efficient, effective, and gentle than traditional approaches.
The truth is that minimally invasive spine surgery (MISS) can be conducted just as well, if not better, without the use of a laser. In fact, in the United States, more than 95 percent of minimally invasive spine treatments are performed without the use of a laser. MISS is determined by the surgical approach to the spine, not the type of scalpel used by the surgeon.
It’s vital to remember that MISS is a surgical procedure for correcting a pathological condition.
It accomplishes this by reducing tissue stress with smaller incisions and creating routes to the spine through more natural cleavage plains. MISS is, in essence, a road rather than a final technique. It’s a less traumatic procedure that allows a surgeon to “get the job done” with less anatomical tissue damage.
Because a laser may be employed in MISS, it looks to be a safer and more effective solution at first glance.
However, as MISS can be done with either a standard scalpel or a laser, it’s important to compare the devices themselves. Why is the traditional surgical approach better if MISS is an option for both traditional and laser spinal surgery? When three essential characteristics of their mechanisms are considered: angles, heat and gas, and depth of penetration, the difference between laser and scalpel becomes clear.
To begin, minimally invasive spine surgeons enter the body by a small incision, frequently using a microscope or endoscope, and must check around corners to determine the source of the problem.
A laser emits a straight beam of light that is ineffective at eliminating lesions that are hidden around corners. The classic scalpel’s ability to navigate angles securely is a key characteristic.
Second, lasers demolish tissue and cut it, but they do so by producing heat and, in some cases, gas (due to the boiling of water molecules). This heat can be transferred to nearby anatomical structures, causing nerve injury. A scalpel, on the other hand, is essentially a razor-sharp knife that separates tissue by cutting but does not produce heat. The precision of a scalpel in the hands of a skilled surgeon is equivalent to that of any laser incision.
The depth of penetration of the tool employed is the third factor to consider. Consider a laser to be a variable-length surgical scalpel. When establishing tissue planes, surgeons typically use a certain degree of tactile pressure to obtain the proper depth of penetration. Consider what a surgeon could do if, while applying pressure to the scalpel, he or she could also click a button that sharpened or dulled the scalpel. Because the surgeon would have no idea how deep he was cutting, this would be a deadly situation. The depth of penetration of lasers cutting into tissue might vary depending on how long the beam sits at one region of the incision. As a result, structures below the targeted depth may be damaged inadvertently. In contrast, a typical scalpel has a steady edge. As a result, an experienced surgeon may calculate the depth of penetration based on the give and take of tissue pressure feedback.
These three factors are the primary reasons why spine surgeons have yet to incorporate the laser into their toolbox. Some may argue that the laser is an appropriate (or perfect) instrument for spine surgery, although this is not widely acknowledged among neurosurgical spine specialists or prominent spine surgeons. For more than 20 years, the laser has been used in spine surgery. It has not acquired widespread acceptability, with the exception of lipomeningocele surgery. While any technique can be refined or adjusted to work in some way, I do not believe that will happen with laser spinal surgery at this time.
Ask yourself a few key questions if you’re considering laser spinal surgery.
- Is the practice or institute you’re considering offering laser-related training at national spine meetings?
- Is this information being disseminated to the medical community in order to improve society?
- Is the surgery they’re proposing one that other well-known doctors in the country and around the world have adopted?
It’s a gimmick if one individual or group performs laser surgery and markets it. When a large number of surgeons use the procedure and long-term studies show that it is safe and effective, laser spine surgery may be a viable choice.
Updates
Think about it. Percutaneous endoscopic laser diskectomy (PELD), percutaneous lumbar disc decompression (PLDD), and target percutaneous laser disc decompression (T-PLDD) were investigated in patients with minimal/mild disc herniations in a study published in 2016. Lasers were shown to be not only less successful than minimally invasive microdiscectomy, but they also resulted in a near doubling of the requirement for a future surgery, according to the study. These aren’t the kinds of findings that would persuade me to reconsider my position on the use of lasers in spine surgery.
Although this approach is gaining favor among the general population, many spine professionals do not support it at this moment.
Most people may not be candidates for laser spine surgery. Make sure you get more than one opinion from a fellowship-trained orthopedic or neurosurgery spine surgeon before deciding on laser spine surgery.
The original version of this article was published in early 2009. My perspective hasn’t changed since then, but in 2011 I came across an intriguing item on Bloomberg News concerning laser spine surgery. It certainly makes you think.